
Class _33^il2i- 
Book. ^-O^ 



(jopyiiglit)J"_ 



coprorGHT DEPosm 



THE ROLLER BANDAGE 



THE 

ROLLER BANDAGE 



BY 

WILLIAM BARTON HOPKINS, M.D. 

SURGEON TO PENNSYLVANIA HOSPITAL AND TO THE 

ORTHOPEDIC HOSPITAL AND INFIRMARY 

FOR NERVOUS DISEASES 



WITH ILLUSTRATIONS 



37/ 



FIFTH EDITION, REVISED 



PHILADELPHIA 

J. B. LIPPINCOTT COMPANY 
1902 



THE LIBRARY OF 
CONGRESS, 

Two Cores Received 

lUN. 9 1902 

r. Copyright entry 

cftASSC^XXc. No, 

COPY B. 




Copyright, 1883 
By J. B. LippiNCOTT & Co. 

Copyright, 1897 
By J. B. LippiNCOTT Company 

Copyright, 1902 
By J. B. LippiNCOTT Company 



Electrotyped and Printed by 
J, B, Lippincott Company ^ Philadelphia^ U.SoA, 



Preface to the Fifth Edition. 



As general proficiency in bandaging and 
in the application of dressings can only be 
obtained by acquiring skill in the handling of 
the roller bandage, the use of the latter may 
well be regarded as the basis of all bandaging, 
for it possesses principles which once learned 
are susceptible of modification to an infinite 
variety of requirements. The title of this 
book, therefore, has its significance. It means 
more than a mere monograph on the roller 
bandage, for the book is intended to teach the 
principles of bandaging as well. 

The destruction by fire of all the plates and 
electrotypes of the former edition has neces- 
sitated the preparation of new illustrations 
throughout and a complete remodelling of the 
book. 



Preface to the Fourth Edition. 



The plan which has been adopted in this 
book, as will be seen at a glance, is to teach 
by numerous illustrations rather than by elab 
orate description the method of applying the 
roller bandage. In order that the student 
may most readily familiarize himself with this 
very important subject, a series of illustra- 
tions is presented which were made in the 
following manner : Each bandage was applied 
to a living model, and whenever the roller 
pursued a course which the author has found 
in his association with students was the cause 
of uncertainty it was at once photographed. 
From these photographs the reproductions 
were made. In this way it is hoped that the 
intricate course traversed by the roller in the 
most complex dressing has been made suf- 
ficiently plain to enable the student to apply it 



PREFACE TO THE FOURTH EDITION 

for himself almost unaided by the text. The 
latter will be found very brief and devoid of 
everything but the rule for application and the 
use to which the dressing is commonly put. 

A series of definitions and general rules for 
bandaging occupy the earlier pages of the 

book. 

W. B. H. 



ContentSe 



The Roller Bandage. Page 

Definition 9 

Material 9 

Rolling « , 10 

By Hand 10 

By Key 10 

By Machine 12 

Size 13 

Uses 14 

Tension 14 

Varieties 19 

Parts 19 

Application. 

To Fix 20 

To Repeat 20 

To Overlap 21 

To Recur 21 

To Reverse. 22 

To Reverse Descending 24 

To Secure 25 

To Remove 26 

ix 



CONTENTS 

Special Bandages. Page 

A Circular Bandage 26 

A Spiral Bandage 26 

An Oblique Bandage 27 

A Spica Bandage 27 

A Figure-of-Eight Bandage 28 

A Spiral Reversed Bandage 28 

A Recurrent Bandage 28 

Bandages of the Head. 

Barton's Bandage 31 

Gibson's Bandage 34 

Occipito-facial Bandage 36 

Crossed Bandage of the Jaw 38 

Recurrent Bandage 40 

Double-Headed Recurrent Bandage 41 

Figure-of-Eight Bandage of one Eye 44 

Figure-of-Eight Bandage of both Eyes 45 

Hunter's V Bandage 46 

White's Head and Neck Bandage 48 

Knotted Bandage 49 

Bandages of the Upper Extremity. 

Desault's Bandage 51 

Velpeau's Bandage 63 

Figure-of-Eight Bandage of the Neck and Axilla 67 

Spica Bandage of the Shoulder 69 

Ascending ... 69 

Descending 72 

Spiral Reversed Bandage of the Upper Extremity. .... 74 
Figure-of-Eight Bandage of the Elbow 79 

X 



CONTENTS 

Page 

Spica Bandage of the Thumb 8i 

Ascending c 8i 

Descending c . . . 82 

Gauntlet Bandage 83 

Demi-Gauntlet Bandage 85 

Bandages of the Trunk. 

Spiral Bandage of the Chest 87 

Anterior Figure-of-Eight Bandage of the Chest 88 

Posterior Figure-of-Eight Bandage of the Chest 90 

Single Spica Bandage of the Breast 91 

Double Spica Bandage of the Breast 93 

Bandages of the Lower Extre^hty. 

Single Spica Bandage of the Groin 97 

Ascending Spica 97 

Descending Spica 100 

Double Spica Bandage of the Groin 102 

Ascending Spica 102 

Descending Spica 105 

Figure-of-Eight Bandage of the Knee 107 

Spica Bandage of the Foot 109 

Incomplete Bandage of the Foot iii 

Complete Bandage of the Foot 113 

Spiral Reversed Bandage of the Lower Extremity. ... 116 

Bandages, Slings, Binders, and Knots. 

T-Bandages 119 

of the Chest o,. 121 

• of the Pubis 121 

of the Ear 123 

xi 



CONTENTS 

Page 

Slings 124 

Four-tailed 127 

Four-tailed of one Eye 128 

Four-tailed of both Eyes 128 

Four-tailed of the Ear 129 

Four-tailed of the Chin 130 

Binders 131 

Knots 134 

Fixed Dressings. 

Preparation of Plaster-of-Paris Bandages 137 

INIode of Application 138 

Application to the Leg 139 

Application to the Hip 145 

Plaster-of-Paris Jacket 146 

Removal of Fixed Dressings 149 



List of Illustrations. 



Fig. Page 

1. Method of rolling the bandage by hand lo 

2. Author's key for rolling bandages ii 

3. Method of rolling the bandage with the key 12 

4. Machine for rolling bandages 13 

5. Double- and single-headed bandages 19 

6. Illustrating the manner of making recurrent turns .... 21 

7. Recurrent bandage of the stump 22 

8. Manner of making reverse 23 

9. Manner of making descending reverse 24 

10. Methods of securing the bandage 25 

11. Spiral bandage applied without reverses 27 

12. Oblique bandage 27 

13. Manner of fixing the bandage by horizontal turns 29 

14. Manner of fixing the bandage by vertical turns 30 

15. Barton's bandage, first turn of 31 

16. Barton's bandage, beginning of the second turn of . . . . 32 

17. Barton's bandage completed 33 

18. Gibson's bandage 35 

19. Occipito-facial bandage 37 

20. Crossed bandage of the jaw 39 

21. Recurrent bandage of the scalp 40 

22. Double-headed recurrent of the scalp, first turn of the 42 

23. Double-headed recurrent of the scalp completed 43 

24. Figure-of-eight bandage of the eye 44 

xiii 



LIST OF ILLUSTRATIONS 

Fig. Page 

25. Figure-of-eight bandage of both eyes 45 

26. Hunter's V bandage 46 

27. White's head and neck bandage 48 

28. Knotted bandage 49 

29. Wedge-shaped axillary pad 51 

30. Desault's dressing, first roller of 52 

31. Desault's dressing, second roller of 55 

32. Desault, manner of commencing the third roller of . . . 56 

33. Desault, manner of continuing the third roller of 58 

34. Desault's dressing completed 59 

35. Author's modification of third roller of Desault 62 

36. Velpeau's bandage, manner of commencing 64 

37. Velpeau's bandage, course of the first spiral turn of . . 65 

38. Velpeau's bandage completed. . ; 66 

39. Figure-of-eight bandage of the neck and axilla 68 

40. Ascending spica of the shoulder, first turn of the 69 

41. Ascending spica of the shoulder 71 

42. Descending spica of the shoulder, first turn of the 72 

43. Descending spica of the shoulder 73 

44. Spiral reversed on the right hand, initial turns of .... . 75 

45. Spiral reversed on the left hand, initial turns of 75 

46. Figure-of-eight turns above and below the thumb .... 76 

47. Point at which reversing begins 77 

48. Spiral reversed bandage of the upper extremity com- 

pleted o 78 

49. Figure-of-eight bandage of the elbow 80 

50. Ascending spica of the thumb 81 

51. Descending spica of the thumb o . . 82 

52. Gauntlet bandage 84 

53. Demi-gauntlet bandage 85 

xiv 



LIST OF ILLUSTRATIONS 

Fig. Pack 

54. Spiral bandage of the chest 87 

55. Anterior figure-of-eight of the chest. 89 

56. Posterior figure-of-eight of the chest 90 

57. Suspensory of the breast, initial turn of 92 

58. Single spica or suspensory of the breast 93 

59. Double spica of the breast, initial turns of 94 

60. Double spica or suspensory of the breast 95 

61. Ascending spica of the groin, initial turns of the 98 

62. Ascending spica of the groin 99 

63. Descending spica of the groin, initial turns of the 100 

64. Descending spica of the groin completed loi 

65. Double ascending spica of the groin, initial turns of the 103 

66. Double ascending spica of the groin 104 

67. Double descending spica of the groin, initial turns of the 105 

68. Double descending spica of the groin 106 

69. Figure-of-eight bandage of the knee 108 

70. Spica bandage of the foot no 

71. Incomplete bandage of the foot, initial turns of the ... in 

72. Incomplete bandage of the foot 112 

73. Heel turn in the complete bandage of the foot 113 

74. Inner malleolar turn in the complete bandage of the 

foot 114 

75. Outer malleolar turn in the complete bandage of the 

foot 115 

76. Spiral reversed bandage of the lower extremity 117 

77. Single T-bandage 118 

78. Double T-bandage » 119 

79. T-bandage of the chest 120 

80. T-bandage of the pubis , . 122 

81. Roller bandage sling of the forearm , 124 

XV 



LIST OF ILLUSTRATIONS 

Fig. Page 

82. Handkerchief sling of the forearm 125 

83. Four-tailed sling 126 

84. Four-tailed sling of the eye 127 

85. Four-tailed sling of both eyes 12S 

86. Four-tailed sling of the ear 129 

87. Four-tailed sling of the chin 130 

88. Many-tailed binder 132 

89. ^Method of applying the binder 133 

90. Double half-hitch of roller bandage 134 

91. Double half-hitch of a sheet 135 

92. Ankle hitch for temporary extension 136 

93. Plaster bandages, method of making 137 

94. Method of suspending a fractured leg for the applica- 

tion of a fixed dressing , . . . 141 

95. Trap-door ; also vertebrated chain to facilitate removal 

of fixed dressing 144 

96. Pelvic rest used for the application of a fixed dressing 

to the hip 145 

97. Suspension apparatus for the application of a plaster- 

of-Paris jacket 147 

98. Hammock for the application of a plaster-of-Paris 

bandage 148 

99. T-shaped rubber strip 150 

100. Reed's cutter 152 

loi. \'an Brun's cutter 153 

102. Plaster shears 153 

103. Darrach's cutter. 154 

104. Pearson's circular saw 155 

105= Saw 155 



The Roller Bandage. 



Definition. — The term roller bandage is 
used to describe a strip of muslin or other 
material rolled into a cylindrical form. When 
other material than muslin is employed, how- 
ever, the bandage is usually designated as 
a rubber, a gauze, a flannel, or a crinoline 
bandage. 

Materials. — Unbleached muslin of medium 
quality is best adapted for the purposes of 
the ordinary roller. This is torn into strips 
of the required length and breadth, remov- 
ing the selvage and leaving the ravel as 
much undisturbed as possible. Gauze for 
aseptic bandages and crinoline for plaster- 
of-Paris are cut into strips of the required 
dimensions, as these materials cannot be 
torn evenly. India-rubber rollers are usually 

9 



THE ROLLER BANDAGE 

procured ready made, though pure rubber 
sheeting of different weights is available for 
special bandages. 

[polling. — The strip of muslin having been 
torn, may be rolled either by hand, by a key, 

Fig. I. 




Method of rolling the bandage by hand. 

or bv a machine. In rolling- bv hand, one 
extremity of the bandage is folded upon itself 
three or four times, when it is handled as a 
cigarette is rolled until the core becomes 
sufficiently firm to resist pressure on end. 
It is then held between the thumb and index 



THE ROLLER BANDAGE 

finger of the left hand, and is made to re- 
volve upon its long axis by the thumb and 
fingers of the right hand, as shown in Fig. i. 
A bandage may be more quickly and firmly 
rolled by using a key, shown in Fig. 2. This 

P'IG. 2. 



MMItlriiMaM I ii^iiaiiiiii^ 



Author's key for rolling bandages. 

is made of brass, has an ordinary key-handle, 
a tapering octagonal shaft, and a smooth tip. 
The dimensions of the shaft are, — four inches 
in length, one-quarter of an inch in diameter 
at the shoulder, and one-fifth at the tip. After 
fixing one extremity of the bandage on the 
key, the latter is made to revolve by the right 
hand, while the left holds the tip of the in- 
strument in its palm, and guides the course 
of the bandage between the thumb and 
fingers. When the roller has reached a 




THE ROLLER BANDAGE 

certain size, it may be held in the manner 
shown in Fig. 3. Any tendency of the roller 
to run off its proper course may be overcome 
by pressure with the little finger of the left 



Fig. 3. 




Method of rolling the bandage with the key. 

hand, if it deviates towards the handle of the 
key, and by pressure with the index finger if 
towards the tip. 

The bandage machine consists of a reel, 
with a crank and octagonal shaft, mounted 
upon a base which is made to screw to a 
table. Set in the base are two uprights, 
which support wooden rods. Through these 



THE ROLLER BANDAGE 

the bandage travels in its course from the 
left hand to the reel, their object being to 
regulate the direction and tension of the 

Fig. 4. 




Machine for rolling bandages. 

roller. After the bandage is rolled, it may 
readily be withdrawn from the machine by 
reversing the direction of the crank and 
pulling out the shaft, as the latter is quite 
movable. This apparatus is shown in Fig. 4. 
Size. — Although bandages vary in length 
13 



THE ROLLER BANDAGE 

from two to ten yards, and in width from 
three-quarters of an inch to four inches, there 
are two sizes in common use with which al- 
most any dressing may be applied. They 
are the roller (two-and-a-half inches by seven 
yards) and \\\^ finger roller (three-quarters of 
an inch by three yards). For children, a 
bandage about half the lencrth and breadth 
of one suitable for an adult may be used. 

Uses. — The roller bandage is used for so 
great a variety of purposes that it would be 
quite beyond the scope of these definitions 
to attempt to enumerate them, except in the 
most general way. To retain almost all 
dressings and splints ; and, by giving support 
or pressure, to prevent or control oedema, 
oozing of blood or serum, spasm of muscles 
after fracture, or as itself a fracture dressing. 

Tension. — Too much care cannot be exer- 
cised in applying a bandage in each individual 
case, to estimate how much tension should be 
used, in order to fulfil the object for which it 
is employed, advantageously and prudently. 

14 



THE ROLLER BANDAGE 

A bandage may be applied tightly, moder- 
ately, or loosely. These grades may be readily 
tried upon one's own person. A tight band- 
age makes a healthy hand throb. A bandage 
moderately applied gives the support of a 
comfortable glove, and a loose bandage is 
one which may retain a compress resting 
upon the eye without causing discomfort. 
The conditions governing the tension of 
the roller will be formulated as (a) those 
depending upon the roller itself, and [b) those 
which exist in the part bandaged : 

a, I . The Circwnfere^ice of the Part Band- 
aged, — The greater the circumference, the 
more force must be used. Thus, in applying 
a roller to the lower extremity, it is necessary, 
in order to secure an equal support for the 
entire limb, that each successive turn cover- 
ing a greater circumference should be drawn 
a little more firmly than the preceding turn. 
The thigh turns require, therefore, consider- 
ably more force to produce a given tension 
than those at the ankle. 

15 



THE ROLLER BANDAGE 

2. Whether the Bandage includes the entire 
or only half the Circumference of the Limb, as 
in the Application of Splints, — When these 
are appHed, much of the force used is di- 
rected upon them, the Hmb receiving less 
pressure than if the roller surrounds it alone. 

3. Incomplete Ba7idagi7tg. — Any bandage 
which leaves a considerable portion of the 
distal extremity of a limb uncovered is very 
liable to induce swelling. If the hand or 
the foot is left uncovered, while the rest of 
the limb is bandaged, swelling is very likely 
to occur. Once started, it progresses very 
rapidly, because it increases the tension of 
the lower border of the bandage. This of 
course promotes the swelling, and so these 
active and passive agents may react upon 
each other to the complete strangulation of 
the limb. 

4. The Character of the Dressing beneath, — 

Where a mass of soft yielding material like 

cotton or gauze is interposed, much more 

force is necessary to give the requisite tension 

16 



THE ROLLER BANDAGE 

than where a thin dressing or none at all is 
used. 

5. Increase of Tension fro^n Flexion or Ex- 
tension, — If a spica bandage is applied to the 
shoulder with the arm elevated, its tension 
will be much increased by bringing the arm 
to the side of the body. In the same manner 
the tension of a spica of the groin, applied 
with the thigh flexed upon the abdomen, will 
be increased when the latter is extended. 

6. The Number of Turns,— Ksich additional 
turn applied to the same part of a limb in- 
creases the tension nearly double. When, 
therefore, a roller starts at the wrist, passes 
to the hand, and returns to the wrist, the 
latter receives too much tension, unless the 
first wrist turns are made very loosely. The 
same is true to a less extent when successive 
turns are made very close together. 

7. Shrinkage. — Due allowance should al- 
ways be made for shrinking of the muslin, if 
it is known or suspected that from any cause 

it will become wet. 

17 



THE ROLLER BANDAGE 

b, I . Texture and Condition of the Tissues. 
— Hard infiltrated tissue, such as is frequently 
found accompanying ulcers of the leg, requires 
very firm pressure, while very moderate press- 
ure only can be employed in bandaging the 
flabby, unresisting limbs of delicate children 
and aged persons. An acute inflammatory 
condition of a part will not admit of pressure, 
while very considerable tension is well borne 
by a doughy, oedematous condition of the 
tissues. 

2. Habit. — Independent of advance or sub- 
sidence of swelling, a bandage may be applied 
more firmly when the patient has become 
accustomed to its presence. 

3. Situation. — Care must be observed, when 
bandages about the chest are applied, that res- 
piration shall not be interfered with, particu- 
larly if the dressing is completed before the 
patient has quite recovered from the effects 
of an anaesthetic. 

4. Change in Position. — Marked swelling 

always occurs when a limb which has been 

18 



THE ROLLER BANDAGE 



kept horizontal for many weeks is suddenly 
allowed to hang. In this way a fixed dressing 
of silicate of sodium or plaster- of-Paris, com- 
fortable while the patient is on his back, fre- 
quently has to be cut when he gets up. 

Varieties. — The single roller, which is almost 
invariably used, and the double roller. They 
are shown in Fig. 5. 

Fig. 5. 





Double- and single-headed bandages. 

Parts of the Roller. — The single roller is 
composed of seven parts, — the initial and 
terminal extremities, the upper and lower 
borders, the external and internal surfaces, 
and the body. The initial extremity is the 
free end, while the terminal extremity is that 

19 



THE ROLLER BANDAGE 

in the centre of the cylinder. The borders, 
upper and lower, are designated according 
to the position they occupy when the sub- 
ject stands erect. The surfaces, inner and 
outer, are denoted by their relation to the 
centre of the cylinder, and the body includes 
all. The double roller has eight parts, — two 
terminal extremities, two borders, two sur- 
faces, two bodies, and no initial extremity. 

Application. 

To Fix. — A roller is fixed by placing the 
outer surface of the initial extremity upon 
the point at which it is to start and holding 
it with the thumb and index finger of the 
left hand. With the body of the roller held 
in the ricrht hand two turns are made in the 
direction taken by the hands of a clock. The 
first turn must be made by the right hand 
alone, after which the left hand, being free, 
may alternate with it. 

To l^cpcat. — To repeat is to make a second 
turn completely hide a preceding turn. This 



THE ROLLER BANDAGE 

is always done in a circular bandage, and in 
fixing the initial extremity. 

To Overlap, — To overlap is to make a second 
turn cover one-half, two- thirds, or three-quar- 
ters of a preceding turn. This is done in all 
spirals. 

Fig. 6. 




Illustrating the manner of making recurrent turns. 



To l^ccur. — To recur is to catch a turn at 
some point and reflect it upon itself, so that 
it either exactly retraces its course or slightly 
diverges in another direction (Fig. 6). This 



THE ROLLER BANDAGE 

is done in recurrents of the stump (Fig. 7) 
and the recurrent of the scalp. (See Fig. 21.) 



Fig. 7. 



•^ 







Recurrent bandage of the stutnp. 



To l^cvcrsc. — To reverse is to bring the 
inner surface of the roller next the skin in- 
stead of the external. The right hand being 
in a state of supination when it receives the 
body of the roller from the left, makes a 
reverse by simply being pronated (Fig. 8). 
While the right hand effects this movement, 
the thumb or index finger of the left is placed 
upon the last turn, which has been applied in 
order to retain it in position, as the free por- 
tion of the roller should hang perfectly slack 
when the reverse is being made. After 



THE ROLLER BANDAGE 

making the reverse, the roller is passed 
around the limb and delivered to the left 
hand, and not until then is the traction neces- 
sary to produce the required tension em- 
ployed. The succeeding reverses are made 

Fig. 8. 




Showing manner of making- reverse. 

in the same manner, and they will be even 
and symmetrical if the thumb or index finger 
of the left hand is placed in the same per- 
pendicular line it before occupied while retain- 
ing the preceding turn, and if each turn is 

23 



THE ROLLER BANDAGE 

made to overlap the preceding one to the 
same extent in its entire circumference. The 
object of the reverse is to make the roller 
adapt itself to a conical cylinder, whose diam- 
eter is increasing, as from the ankle to the 
calf of the leg. 

Fig. 9. 




Showing manner of making descending reverse. 

To Reverse, Descending. — To make a descend- 
ing reverse, the right hand is placed in a state 
of pronation when about to receive the body 
of the roller from the left, and is simply tunned 

24 



THE ROLLER BANDAGE 

to supination, while the left thumb retains the 
turn already made as in the ordinary reverse 
(Fig. 9). The descending reverse becomes 
necessary when the roller is applied to a part 
the diameter of which is constantly diminish- 
ing, as in the leg from the calf to the knee 
when the former is very large, and when 
thickly padded splints are applied to the 
hand, etc. 

To Secure. — To secure the terminal ex- 
tremity of the roller, either a pin is used, 

Fig. 10. 




fe 



Methods of securing the bandage. 

which includes one or more of the previous 
turns, or the end is slit into two tails, which 
are carried around the part in opposite direc- 
tions and tied. The pin may be introduced 
parallel or at right angles with the long axis 
of the limb. These methods of securing are 

25 



THE ROLLER BANDAGE 

shown in Fig. lo. The pin should always be 
directed downwards ; it should appear to view 
at least twice in its course through the under- 
lying layers of muslin, and its point should 
be carefully buried. These precautions are 
necessary to prevent the pin doing harm, as 
the hand of the operator is usually carried 
down the limb to ascertain if the roller has 
been properly applied. 

To Remove. — When removing the roller, 
each turn should be gathered compactly in 
the hand, no loops or ends being allowed to 
trail. 

Special Bandages. 

A Circular Bandage. — A circular bandage 
consists of a series of three turns which 
repeat each other. 

A Spiral Bandage. — A spiral bandage is one 

each turn of which, after the initial extremity 

has been fixed, overlaps one-half, two-thirds, 

or three-quarters of the preceding turn. Such 

a bandage applied to a part having varying 

26 



THE ROLLER BANDAGE 

diameters will not adapt itself evenly and 
neatly (Fig. ii). 

Fig. II. 

Spiral bandage applied without reverses. 

An Oblique Bandage. — An oblique bandage 
resembles a spiral, except that the limb is 
ascended so rapidly that the borders of the 

Fig. 12. 




Oblique bandage. 



:^ 



turns do not touch one another. It is only 
used to retain a temporary or loose dressing 

(Fig. 12). 

A Spica Bandage. — A spica bandage is com- 
posed of two sets of turns alternating with 

27 . 



THE ROLLER BANDAGE 

one another, and coming in contact only at 
the point where it is intended to make press- 
ure or retain a dressing. (See Fig. 41, 
page 71.) 

A Figurc-of-Eight Bandage. — A figure-of-eight 
bandage frequently resembles a spica very 
closely. It also is composed of two sets of 
turns made in different directions, but the 
direction of these turns gradually converges. 
(See Fig. 49, page 80.) 

A Spiral Reversed Bandage. — A spiral re- 
versed bandage consists of a series of spiral 
turns, most of which have been reversed. 
(See Fig. 48, page 78.) 

A Recurrent Bandage. — A recurrent bandage 
is composed of a series of recurrent turns. 
(See To Recttr, page 21.) 



28 



Bandages of the Head. 



All bandages applied to the head, except 
Barton's, are fixed either by circular turns 



Fig. 13. 




i 



Manner of fixing the bandage by horizontal turns. 

running horizontally about the vault of the 
cranium, or by circular turns vertically around 

29 



THE ROLLER BANDAGE 

the face. After the former method are fixed 
the crossed of the angle of the jaw, recurrent 
of scalp, figure-of-eights of the eye. Hunter s, 

Fig. 14. 




H 



Manner ol fixing the bandage by vertical turns. 

White's, and the knotted bandage (Fig. 13), 
while Gibson's and the occipito-facial are fixed 
by the latter (Fig. 14). 



30 



BANDAGES OF THE HEAD 
Barton's Bandage. 

2 inches by 5 yeords. 

Place the initial extremity of the roller be- 
hind the ear on the sound side. Carry the 




The first turn of Barton's bandage. 

roller beneath the occiput to a corresponding 
point behind the ear on the injured side. 

31 



THE ROLLER BANDAGE 

Thence to the vertex, and down the sound 
side of the face to the chin. Up on the in- 
jured side to the vertex, intersecting the 

Fig. i6. 




The beginning of the second turn of Barton's bandage. 

former turn directly in the median hne, and 
back to the starting-point. Not until then is 
the bandage fixed. The fingers holding the 

32 



BANDAGES OF THE HEAD 

initial extremity are now released, and the 
roller may be conveniently passed from one 
hand to the other (Fig. 15). The roller 
passes from here to the occiput, and along 

Fig. 17. 




Barton's bandage completed. 



the injured side of the jaw to the chin, and 
back to the occiput. From the occiput to the 
vertex (Fig. 16). Each of these turns is re- 
peated in a similar manner twice, when the 
3 33 



THE ROLLER BANDAGE 

bandage is terminated at the vertex. Every 
intersection of turns requires a pin (Fig. 17). 

Uses. — Fracture of the body of the lower 
jaw, after luxation, and to retain dressings at 
various points along the course traversed by 
the bandage. 

It is also a useful substitute for the leather 
head-gear of Sayre's suspension apparatus 
for applying the plaster jacket, when the 
latter is not available. 



Gibson's Bandag[e. 

2 inches by 5 yards. 

Fix the roller by vertical turns around the 
face. The direction it takes in starting is de- 
termined by the location of the fracture, the 
roller always ascending on the injured side. 
After making three of these vertical turns, a 
right-angled reverse is made at the temple, 
on whichever side is more convenient, and 
the bandage is carried back to the occiput 

34 



BANDAGES OF THE HEAD 

(Fig. 14). Three horizontal turns are then 
made around the vault of the cranium, and, on 
reaching the occiput the third time, the chin 

Fig. 18. 




Gibson's bandage. 

turns are begun. These are made by carrying 
the roller beneath the ear, along the side of 
the jaw, to the front of the chin, and back to 
the occiput. Three of these turns are made. 

35 



THE ROLLER BANDAGE 

On reaching the occiput the third time, the 
bandage is completed by a right-angled re- 
verse at this point, whence it is carried over 
the top of the head to the forehead in the 
median line (Fig. i8). A pin is introduced at 
the reverse over the occiput, and at each inter- 
section. The dressing will be seen to consist 
of three sets of circular turns. 

Uses. — Fracture of the body of the lower 
jaw, after luxation, and to retain dressings. 



Occipito-Facial Bandag^e. 

2 inches by 2 yards. 

Fix the roller by vertical turns around the 
face. After making three of these turns, re- 
verse over the temple on the more convenient 
side, carry the roller to the occiput, and back 
to the opposite temple. It may be pinned 
here (Fig. 19), or continued around the fore- 
head to the point at which the reverse was 
made. The reverse must also be pinned. 

3^ 



BANDAGES OF THE HEAD 

The bandage consists simply of the first and 
part of the second circulars of Gibson's. 

Fig. 19. 




r^ 




Occipito-facial bandage. 



Uses. — To restrict the movement of the jaw 
after luxation, and to retain dressings. 



37 



THE ROLLER BANDAGE 
Crossed Bandag^e of the Jaw. 

2 inches by 5 yards. 

Fix the roller about the vault of the cranium, 
delivering it from the left to the right hand, if 
the jaw is fractured on the left side, and from 
the right to the left, if the fracture is on the 
right side. On reaching the occiput the third 
time, carry the roller beneath the ear, under 
the chin to the angle of the mouth on the 
opposite side. Ascend to the vertex. De- 
scend behind the ear on the sound side to the 
throat, and up again on the injured side to 
the vertex. Each ascending turn overlaps 
the preceding turn three-quarters. Each de- 
scending turn passes behind the ear on the 
sound side, and exactly repeats the preceding 
turn. So continue until the angle of the jaw 
on the injured side is covered. This is usually 
accomplished in about four turns, when the 
bandage may be pinned (Fig. 20), or a right- 
angled reverse made over the temple, and a 

38 



BANDAGES OF THE HEAD 

circular turn, repeating those applied at the 
beginning, carried around the head. 



Fig. 20. 



4 




Crossed bandage of the jaw. 



Use. — Fracture of the lower jaw with 
lateral displacement. 



39 



THE ROLLER BANDAGE 
Recurrent Bandage* 

2 inches by 7 yards. 

Fix the roller about the vault of the 
cranium. On reaching the occiput the third 
time, make a right-angled reverse, and carry 

Fig. 21. 




Recurrent bandage of the scalp. 

the roller in the median line over the top of 
the head to the brow, at which point the 
finger of an assistant must hold the band- 
age. Recur to the occiput, overlapping three- 

40 



BANDAGES OF THE HEAD 

quarters of the first turn on one side. Recur 
to the forehead, overlapping three-quarters on 
the other side of the first turn. So continue 
until the entire scalp is covered, when two 
circular turns are made to fix the recurrents. 
Pin deeply into the layers in front and at the 
the back (Fig. 21). 

Uses. — To retain dressings to the scalp, and 
to make compression. 



Double-Headed Recurrent Banda£(e. 

2 inches by 14 yards. 

Place the free portion between the two 
bodies of the roller upon the forehead and by 
carrying the heads around the vault of the 
cranium make one horizontal turn. At the 
occiput a hitch is made, and while one head 
of the bandage is carried forward accurately 
in the median line, the other head begins 
its continuous course horizontally about the 
vault of the cranium. Passing beneath this 

41 



THE ROLLER BANDAGE 

(Fig. 22), the recurrent head of the bandage 
is reflected upon itself, and diverging to the 
left from its original course so that it shall 
overlap the preceding turn three-quarters of 
its width at the vertex, it is carried back to 

Fig. 22. 



t 





/ 






The first turn of the double-headed recurrent of the scalp. 

the occiput. Here, again retained firmly in 
place by the horizontal head, it is reflected 
upon itself and carried forward to the right 
of the median line. Thus each recurrent turn 
is retained by a circular turn both anteriorly 

42 



BANDAGES OF THE HEAD 

and posteriorly until a sufficient number are 
made to completely cover the scalp (Fig. 23), 
when the terminal ends are pinned together 
at any convenient point. 

Fig. 23. 





The double-headed recurrent of the scalp completed. 

Uses. — To retain dressings in restless or 
delirious subjects. Though somewhat diffi- 
cult to apply neatly, it is so secure that it 
cannot become disarranged. 



43 



THE ROLLER BANDAGE 



Figure-of-Eight Bandage of One Eye. 

2 inches by 5 yards. 

Fix the roller about the vault of the cranium, 
bandaging from left to right, if the right eye 
is to be covered, and from right to left, if the 

Fig. 24. 




% 



Figure-of-eight bandage of the eye. 

left eye. On reaching the occiput the third 
time, pass the bandage below the ear, across 
the eye, and to the tuberosity of the parietal 
bone on the opposite side. Thence to the 
occiput. Repeat this turn twice, and again 

44 



BANDAGES OF THE HEAD 

follow the initial turns around the head. Pin 
both intersections (Fig. 24). 

Uses. — To retain dressings, and make com- 
pression upon the orbit. 



Figure-of-Eight Bandage of Both Eyes. 

2 inches by 7 yards. 

Fix the roller around the head. Cover 
one eye as in the preceding bandage, and, 

Fig. 25. 



I 




Figure-of-eight bandage of both eyes. 

after making one circular about the head, 
proceed, on reaching the forehead, to cover 

45 



THE ROLLER BANDAGE 

the other eye in a similar manner (Fig. 

25). 

Uses. — To retain dressings, or compress 

both eyes. 

Hunter's V Bandag^e. 

2 inches by 3 yards. 

Fix the roller about the vault of the cranium. 
On reaching the occiput the third time, carry 

Fig. 26. 




Hunter's V bandage. 



the bandage beneath the ear, along the jaw 

to the front of the chin, and back to the 

46 



BANDAGES OF THE HEAD 

occiput. Then alternate between head and 
chin turns, making two or three of each. 
This bandage follows the same course as 
the second and third circulars of Gibson's 
(Fig. 26). 

Uses. — To retain dressings after injuries 
and operation about the chin or lower lip. 



47 



THE ROLLER BANDAGE 
White's Head and Neck Bandage. 

2 inches by 3 ys^ds. 

Fix the roller about the vault of the cranium, 
and on reaching the occiput the third time, 

Fig. 27. 




% 



1 

White's head and neck bandage. 

pass directly down in front of the throat. 

Alternate two or three head and neck turns, 

and pin the bandage at the most convenient 

point (Fig. 27). 

Uses. — To retain dressings after injuries 

and operation of the throat or neck. 

48 



BANDAGES OF THE HEAD 
Knotted Bandage. 

2 inches by 7 yards. 

For this a double-headed roller is employed. 
Place the free portion between the bodies upon 
the temple on the injured side, and carry the 

Fig. 28. 



Knotted bandage. 

heads around the vault of the cranium, to a 

corresponding point on the opposite side. 

Here the heads of the roller pass each other, 

and continue their course back to the starting- 
4 49 



THE ROLLER BANDAGE 

point. When this point is reached, they make 
a half turn upon each other, and pursue a 
vertical course around the face, passing as 
before on the sound side. Reaching the in- 
jured side again, another hitch is made, and 
the roller is carried horizontally around the 
head. So alternate face and head turns until 
three or four knots have been made, when 
the terminal extremities may be tied together 
or pinned at the most convenient point (Fig. 

28). 

Use. — To make pressure upon the temple, 
especially for the control of hemorrhage. 



50 



Bandages of the Upper Extremity. 



Desault's Dressing. 

This bandage is compound in character, 
requiring for its application three rollers and 



Fig. 29. 




Wedg-e-shaped axillary pad. 

a wedge-shaped pad. The pad is made of 
strong muslin stuffed with hair or bran, is 
about five inches square, two inches thick at 
the base, and bevels off to nothing at its 
apex (Fig. 29). 

51 



THE ROLLER BANDAGE 



First Roller of Desault. 
2^ inches by 5 yards. 

Place the initial extremity of the roller on 
the pad, the base of which is thrust into the 

Fig. 30. 




First roller of Desault's dressing. 

axilla on the injured side, and make four 
spiral turns, encircling the thorax and pad. 



52 



BANDAGES OF THE UPPER EXTREMITY 

On reaching the pad the fourth time, carr^^ 
the roller well down under its apex, and 
thence across the front of the chest to the 
shoulder on the sound side. Here a figure- 
of-eieht turn around the arm is made, and the 
roller conveyed across the back to the apex 
of the pad again. Two more of these turns 
are made, either repeating each other, or, as 
shown in Fig. 30, overlapping to form a spica 
on the shoulder. The terminal extremity is 
then pinned at the most convenient point in 
front. 

Use. — The spiral turns are to fix the pad, 
and the figure-of-eight turns to force it up 
into the axilla. A mass of oakum compressed 
into a wedge-shaped form and folded in lint 
or muslin may well be used instead of the 
prescribed pad, as it better retains its position 
and can be renewed at each dressino-. 



S3 



THE ROLLER BANDAGE 

Second Roller of Desault. 
2^ inches by 7 yards. 

Fix the initial extremity of the roller by 
two circular turns, which include the thorax 
and the arm on the injured side. They pass 
over the head of the humerus and under the 
sound axilla. Descend the chest and arm by 
spirals, overlapping one-half. These turns 
must constantly increase in tension until the 
elbow is reached, when the bandage is pinned. 
The spirals may converge somewhat on the 
sound side, so that they overlap three-quar- 
ters (Fig. 31). 

Use. — To force the head of the humerus 
outwards. This is done by the action of the 
lower spiral turns. These being applied with 
more tension than the upper ones convert the 
shaft of the bone into a lever, the fulcrum of 
which corresponds to the pad. 



54 



BANDAGES OF THE UPPER EXTREMITY 



Fig. 31. 




-mm 




Second roller of Desault's dressing. 



55 



THE ROLLER BANDAGE 




Showing the manner of commencing the third roller of Desault. 



56 



BANDAGES OF THE UPPER EXTREMITY 

Third Roller of Desault. 
2>^ inches by 7 yards. 

Place the initial extremity of the roller 
under the axilla on the sound side, and carry- 
it obliquely across the front of the chest to 
the middle of the summit of the shoulder on 
the injured side. Down behind the humerus, 
and parallel with it, to the elbow ; under the 
latter, and across the front of the chest to the 
axilla on the sound side, where the initial ex- 
tremity is met and fixed (Fig. 32). The roller 
now passes under the axilla, obliquely across 
the back to the middle of the summit of the 
shoulder on the injured side. Down in front 
of the humerus, and parallel with it to the 
elbow ; under the elbow, and across the back 
to the axilla on the sound side, which com- 
pletes one entire turn, — an anterior and a 
posterior triangle (Fig. 33). From this point 
it emerges, and is in position to cross the 
front of the chest to the shoulder on the in- 
jured side as before, and descend behind the 

57 



THE ROLLER BANDAGE 

humerus, and pass under the elbow, back 
again to the axilla. Another posterior turn 

Fig. 33. 




Showing the manner of continuing the third roller of Desault. 

is then made. In this way three anterior and 
three posterior triangles are formed, which 

58 



BANDAGES OF THE UPPER EXTREMITY 

exactly repeat each other, and the end of the 
roller is pinned at any point in front. Each 

Fig. 34. 




Desault's dressing completed. 



intersection also must be secured by pins or 
adhesive plaster, and a sling to support the 

59 



THE ROLLER BANDAGE 

forearm and hand completes the dressing 

(Fig. 34). 

Use. — To draw the shoulder upwards and 

backwards. To accomplish this, it is evident 
that the posterior turns must be applied with 
more tension than the anterior. 

The bandage of Desault as a whole is em- 
ployed usually for fracture of the clavicle. 
Portions of the dressing are, however, fre- 
quently used for other purposes ; the second 
roller being applied when it becomes neces- 
sary to retain the arm to the side of the body 
for any cause, as in fracture of the humerus. 
The third roller may be used after dislocation 
of the head of the humerus or of the acro- 
mial end of the clavicle. 



60 



BANDAGES OF THE UPPER EXTREMITY 

Third Roller of Desault Modified by the 
Author. 

In order to obtain a more direct elevating 
force, the third roller may be applied as 
shown in Fig. 35. To do this, place the 
initial extremity under the sound axilla, carry 
the roller obliquely across the front of the 
chest to the shoulder on the injured side, 
down behind the arm and parallel to it, and 
under the elbow, as in Desault. From the 
elbow the roller ascends obliquely across the 
forearm and front of the chest to the sitmmit 
of the shoulder on the sound side, and down 
obliqtiely across the back to the elbow on the 
injured side. Thence it ascends the arm to 
the shoulder on the injured side, and returns 
across the back to the axilla on the sound 
side. Here it fixes the initial extremity, and 
two more similar turns are made, which ex- 
actly repeat each other, when the terminal 
end is secured as in the original bandage. 

The anterior turns applied in this way lose 

61 



THE ROLLER BANDAGE 

to a great extent their power to draw the 
shoulder forward. The necessary precaution, 

Fig. 35. 




Third roller of Desault as modified by the author. 

to use more tension for the posterior than the 

anterior turns, when the roller is applied in 

62 



BANDAGES OF THE UPPER EXTREMITY 

the ordinary way, is therefore not required, 
as the direction of the forces and their rela- 
tive points of application are of themselves 
sufficient to effect this result, besides gaining 
a greater elevating force. 



Velpeau's Bandage. 

2>^ inches by 14 yards (two seven-yard rollers). 

Having placed the hand of the injured side 
upon the sound shoulder, the initial extremity 
is started over the spine of the scapula on 
the sound side, and the roller carried across 
the back to the injured side, pursuing the fol- 
lowing course : the middle of the summit of 
the shoulder ; the middle of the outer aspect 
of the arm, behind the elbow, across to the 
axilla on the sound side, and under it to 
the starting-point. Repeat this turn to fix 
the bandage (Fig. 36). On reaching the 
scapula the second time, make a circular 
turn around the thorax, including in it the 
arm on the injured side. The external con- 

63 



THE ROLLER BANDAGE 



Fig. 36. 




/ 



X 




.^ 



\ 



\ 







Showing the manner of commencing Velpeau's bandage. 



64 



BANDAGES OF THE UPPER EXTREMITY 

dyle of the humerus being the point over 
which the middle of the roller passes (Fig. 

Fig. z1' 




Showing the course of the first spiral turn of Velpeau's bandage. 

37), on its way back to the starting-point. 
A shoulder turn is now made, which over- 
laps the fixing turn three-quarters towards 
5 65 



THE ROLLER BANDAGE 

the median line of the body. Then another 
circular (ascending spiral) turn overlapping the 
preceding turn one-half. So, shoulder turns 

Fig. 38. 




Velpeau's bandage completed. 

and spiral turns alternate until the former 
support the point of the elbow. After this 
spiral turns alone are continued, until the 
entire extremity up to the wrist is thoroughly 

66 



BANDAGES OF THE UPPER EXTREMITY 

supported. No sling is used in this dressing. 
Pins or adhesive plaster must be freely used 
over the shoulder and about the elbow (Fig. 

38). 

Uses. — Fracture of the clavicle, and after 
dislocation of the humerus. The point of 
the elbow should be carefully protected from 
pressure by a perforated lint pad. 



Figure-of- Eight Bandage of the Neck and 
Axilla. 

2 inches by 4 yards. 

Fix the initial extremity by circular turns 
around the neck. Descend from the neck 
to the axilla, carrying the roller from before 
backwards, if the right axilla is to be in- 
cluded, and from behind forwards, if the left. 
Pass under the axilla, ascend to the neck, 
and encircle it. So alternate between neck, 
and axillary turns, until three have been 

made, either repeating one another, or, as 

67 



THE ROLLER BANDAGE 

shown in Fig. 39, overlapping three-quarters. 
It may be terminated and secured at any 
point the roller runs out. 



Fig. 39. 




Figure-of-eight bandage of the neck and axilla. 

Uses. — To retain dressings after injuries 
and operation about the shoulder and axilla. 

68 



BANDAGES OF THE UPPER EXTREMITY 



Spica Bandages of the Shoulder. 

ASCENDING SPICA. 

ZYz inches by 7 yards. 

Fix the initial extremity slightly above the 
middle of the arm on the injured side. 

Fig. 40. 




Showing the first turn of the ascending- spica of the shoulder. 

Carry the roller across the front of the 

chest (if the right is the injured side, across 

69 



THE ROLLER BANDAGE 

the back if the left) to the opposite axilla ; 
passing under this, return by the back (or 
by the chest if the left side is being band- 
aged) to the injured side. In the ascending 
spica the lower border of the roller deter- 
mines the position of the spica. This turn, 
therefore, should cross the previous turn, so 
that the lower borders of both intersect at the 
outer side of the arm (Fig. 40). Encircle the 
arm and overlap ascending two-thirds. Pass 
to the opposite axilla, gradually converging 
with the preceding turn so that at this point 
it will repeat it. So alternate between body 
and arm turns until the shoulder is covered, 
when the bandage may be secured by a pin 
at any convenient point (Fig. 41). 

Uses. — To retain dressings and splints to 
the shoulder. 



70 



BANDAGES OF THE UPPER EXTREMITY 



Fig. 4^' 








Ascending spica of the shoulder. 



71 



THE ROLLER BANDAGE 

DESCENDING SPICA. 

2>^ inches by 7 y&rds. 

Fix the initial extremity to the upper part 
of the arm. Carry the roller to the base of 

Fig. 42. 




^ V 



W 



Showing the first turn of the descending spica of the shoulder. 



the neck, and pass across the front of the 

chest (or the back, if the left side is being 

bandaged) to the opposite axilla. Return 

72 



BANDAGES OF THE UPPER EXTREMITY 

across the back (or front of the chest, if the 
left side) to the base of the neck on the 
injured side. In the descending spica, the 



Fig. 43- 




Descending spica of the shoulder. 

Upper border of the bandage determines the 
position of the spica. The upper borders 
of this turn and the preceding one should, 
therefore, coincide at the junction of the 
base of the neck and summit of the shoulder 

73 



THE ROLLER BANDAGE 

(Fig. 42). Pass under the axilla on the in- 
jured side, and so continue overlapping two- 
thirds descending at the spica and converging 
under the axilla on the sound side, until the 
shoulder is covered (Fig. 43). Pin the termi- 
nal extremity at the spica, or at any conve- 
nient point. 

Uses. — To retain dressings higher up on 
the shoulder than can be neatly done by the 
ascending spica. 



Spir2j Reversed Bandage of the Upper 
Extremity. 

7,y2 inches by 7 yards. 

Fix the initial extremity at the wrist, carry- 
ing the roller from left to right in bandaging 
either side. Pass across the back of the hand 
(from the ulnar to the radial side," if the right 
hand, and from the radial to the ulnar, if the 
left) to the tips of the fingers (Figs. 44 and 45). 
Here make a circular and a spiral reversed 
turn. Two figure-of-eight turns above and 

74 



BANDAGES OF THE UPPER EXTREMITY 

Fig. 44. 




-X 



•^ 



r 



^ 



Initial turns of spiral reversed on the right hand. 



Fig. 45. 







/ 



\ 



N J 



Initial turns of spiral reversed on the left hand. 

75 



THE ROLLER BANDAGE 

below the thumb are then made (Fig. 46), 
and the roller Is carried up to the wrist. Con- 
tinue up the forearm with spiral turns until the 
diameter of the latter increases sufficiently to 



Fig. 46. 




Showing figiire-of-eight turns above and below the thumb. 

render reverses necessary (Fig. 47). Make 

these until a point near the elbow is reached, 

when spiral turns take their place until the 

increasing diameter of the arm requires 

76 



BANDAGES OF THE UPPER EXTREMITY 



Fig. 47. 




A^ 



i 



Showing the point at which reversing begins. 



77 



THE ROLLER BANDAGE 



Fig. 48. 



'W 



Spiral reversed bandage of the upper extremity completed. 



78 



BANDAGES OF THE UPPER EXTREMITY 

reversing upon. A few more spiral turns com- 
plete the bandage (Fig. 48). The elbow may 
be covered by figure-of-eight turns, particu- 
larly if the forearm is to be retained in a flexed 
position, as shown in Fig. 49, and presently 
to be described. 

Uses. — To retain dressings and splints to 
the part, etc. 



Figure-of-eight Bandage of the Elbow, 

2}^ inches by 2 yards. 

Fix the initial extremity by circular turns 
over the point of the elbow. After reaching 
the front of the joint the third time carry the 
roller upwards, so that a turn shall be made 
which overlaps the fixing turns two-thirds 
ascending. On returning to the front of the 
joint carry the roller downwards, so that a 
turn shall be made which overlaps the fixing 
turns two-thirds descending. Thus alternate 
above and below the joint with turns which 
continue to diverge from the olecranon, but 

79 



THE ROLLER BANDAGE 

overlap (approximately) in front of the elbow, 
until four or five complete figures-of-eight 
have been made, when the terminal extremity 
is pinned at the front (Fig. 49). 

Fig. 49. 




Figure-of-eight bandage of the elbow. 



Uses. — To retain dressings and as part of 
the spiral reversed bandage of the upper ex- 
tremity. 



80 



BANDAGES OF THE UPPER EXTREMITY 
Spica Bandage of the Thumb. 

ASCENDING SPICA. 
I inch by 3 yards. 

Fix the initial extremity at the wrist, carry 
the roller to the tip of the thumb, and make a 

Fig. 50. 




Ascending- spica of the thumb. 

circular turn. Make a series of figure-of- 
eight turns of the thumb and wrist, over- 
lapping (ascending) two-thirds ; the intersec- 
tions, or spicas, being made over the dorsum 
6 81 



THE ROLLER BANDAGE 

of the thumb (Fig. 50). Pin the terminal end 
at the wrist. 

Uses. — To retain dressings and sphnts to 
the part. 

DESCENDING SPICA. 

I inch by 3 yards. 

Fix the initial extremity at the wrist, carry 
the roller to the metacarpo-phalangeal joint 

Fig. 51. 




Descending spica of the thumb. 

of the thumb, and make a circular turn. Re- 
turn to the wrist, and, with alternating thumb, 

82 



BANDAGES OF THE UPPER EXTREMITY 

and wrist turns which overlap two- thirds, de- 
scend towards the tip of the thumb. Here 
also each spica should be made over the 
dorsum of the thumb. The terminal end is 
secured at the wrist (Fig. 51). 

Uses. — To retain dressings, and after luxa- 
tion of the base of the metacarpal bone of 
the thumb. 



Gauntlet Bandage. 

I inch by 5 yards. 

Fix the initial extremity at the wrist, and 
carry the roller abruptly across the back of 
the hand to the tip of the index finger (if the 
right hand; to the tip of the little finger if the 
left), and make a circular turn, after which 
the finger is ascended by a series of spiral 
turns. Some reverses may be necessary if the 
fingers are cedematous, or if a very bulky 
dressing is to be retained, but ordinarily none. 
When the finger is covered, pass across the 
back of the hand to the wrist, and there make 

83 



THE ROLLER BANDAGE 

another circular turn. In like manner each 
finger is bandaged, and finally the thumb, 

Fig. 52. 




%j 



Gauntlet bandage. 

when the terminal end is pinned at the wrist 

(Fig- 52). 

Uses. — To retain dressings after burns and 
scalds. To apply splints. One or two fingers 
only are generally covered, the dressing as a 

whole being seldom used. 

84 



BANDAGES OF THE UPPER EXTREMITY 



Demi-Gauntlet Bandage. 

I inch by 3 yards. 

Fix the initial extremity at the wrist. Carry 
the roller across the back of the hand to the 

Fig. 53. 




Demi-gauntlet bandage. 

base of the index finger (if the right hand, 
to the base of the little finger if the left), 

85 



THE ROLLER BANDAGE 

encircle this, and return in the opposite direc- 
tion across the back of the hand to the wrist. 
So continue until all the fingers have had this 
loop thrown over them, including finally the 
thumb, when the terminal extremity is pinned 
at the wrist (Fig. 53). Here, as in the gaunt- 
let, it is better to make a complete circular 
turn of the wrist after each fino-er is covered. 
Uses. — To retain light dressings to the dor- 
sum of the hand. 



86 



Bandages of the Trunk. 



Spiral Bandage of the Chest. 

3 inches by 7 yards. 

Fix the initial extremity about the waist. 

Fig. 54. 




Spiral bandage of the chest. 

Ascend the chest by spiral turns, overlap- 
87 



THE ROLLER BANDAGE 

ping one-half, until a point just below the 
level of the axillae is reached. At the spine, 
recur across the left shoulder to the sternum, 
and back across the right shoulder to the 
spine. Secure each recurrent with a pin 

(Fig. 54). 

Uses. — To support the chest, as after frac- 
ture of the ribs, or to retain dressings to it. 



Anterior Figure-of-Eight Bandage of the 
Chest. 

2^ inches by 7 yards. 

Fix the initial extremity on the upper part 
of the right arm, and carry the roller across 
the shoulder and front of the chest to the left 
axilla. Pass under this, over the left shoul- 
der, and across the front of the chest to the 
right axilla. Encircle the right shoulder from 
below upwards, and return to the left side as 
before. So proceed until three or four turns 
have been made. These may repeat one an- 
other throughout, or may overlap three-quar- 



BANDAGES OF THE TRUNK 

ters over the sternum. The terminal end is 
secured at any convenient point in front 

(Fig- 55)- 

Fig. 55„ 



m 



S'^\ 



Anterior figure-of-eight of the chest. 



Uses. — To draw the shoulders together an- 
teriorly, and to retain dressings. 



89 



THE ROLLER BANDAGE 

Posterior Fig'ure-of-Eight Bandage of the 
Chest. 

2 2 inches by 7 yards. 

Fix the initial extremity on the upper part 
of the left arm. Carrv the roller over the 






Pc5:eri:r i 



summit of the left shoulder, and across the 

back to the rio'ht axilla. Passino' under this 

90 



BANDAGES OF THE TRUNK 

and to the summit of the shoulder, aeain cross 
the back to the left axilla, where the left shoul- 
der is encircled in a similar manner. After 
making four or five of these turns, pin the 
terminal end in front. Each turn may repeat 
throughout, or overlap over the spine three- 
quarters, as shoAvn in Fig. 56. 

Uses. — To draw the shoulders together pos- 
teriorly, and to retain dressings over the 
upper part of the back. 



Spica Suspensory Bandages of the Breast. 

SINGLE SPICA. 

2^2 inches by 7 yards. 

Place the initial extremity on the scapula 
upon the affected side. Carry the roller across 
the back to the summit of the opposite shoul- 
der, and thence down under the lower portion 
of the affected breast, beneath the axilla, to 
the starting-point. Repeat this turn (Fig. 57) 
to fix the initial extremitv. On reachino- the 
scapula the second time, make the first circular 

91 



THE ROLLER BANDAGE 

turn around the chest. This should pass 
under the sound breast and across the lower 
border of the affected breast. Having com- 

FiG. 57. 




Initial turn of suspensory of the breast. 

pleted this circular, another shoulder turn is 
made, which overlaps the previous one three- 
quarters, ascending. Then another circular, 

which overlaps the preceding circular one- 

92 



BANDAGES OF THE TRUNK 



half over the affected breast, three-quarters 
under the sound breast. So shoulder turns 
and circulars alternate, until the breast is 

Fig. 58. 




Single spica or suspensory of the breast. 

thoroughly supported, when the terminal end 
may be pinned at any point in front (Fig. 58). 
Uses. — To retain dressings to the part. To 
give support or compression. 

93 



THE ROLLER BANDAGE 



Double Spica. 

2j^ inches by 10 yards. 

The initial extremity is fixed in the same 
way as in applying the single spica. (Fig. 57). 

Fig. 59. 






Initial turns of double spica of the breast. 

On reaching the left scapula the second time, 
carry the roller straight across the back to the 
right scapula, under the axilla and right breast 

94 



BANDAGES OF THE TRUNK 

to the opposite shoulder. Passing from here 
to the right scapula, the first circular turn be- 
gins. It should encircle the chest on a line 
that will include the lower border of both 

Fig. 6o. 




'A 



Double spica or suspensory of the breast. 

breasts (Fig. 59). When this turn is com- 
pleted, the roller passes to the summit of the 
right shoulder, and descends to include the 
left breast. Again it is carried across the 

95 



THE ROLLER BANDAGE 

back, under the right axilla, and ascends, in- 
cluding the right breast, to the left shoulder. 
Then a second circular turn is made. In 
this way left breast, right breast, and circular 
turns alternate, the two former overlapping 
two-thirds, the latter one-half, until both 
breasts are covered. Three series of spicas 
are thus formed, — one over the sternum and 
one under each breast (Fig. 60). The termi- 
nal extremity may be pinned at any point in 
front. 

Uses. — To retain dressings, and to give sup- 
port or pressure to both mammae. 



96 



Bandages of the Lower Extremity. 



Sing^le Spicd^ Bondage of the Groin. 

^Yz inches by 7 yards. 
ASCENDING SPICA. 

Fix the initial extremity about the upper 
part of the thigh, and carry the roller across 
the pubis to the crest of the ilium on the op- 
posite side (if the right groin, while if the left 
the roller is carried first to the crest of the 
ilium on the affected side). Thence around 
the body, return to the starting-point and 
encircle the thigh. As the lower border 
of the roller in each turn determines the 
position of the spica, it should intersect 
directly in front of the thigh and the roller 
be made to overlap two-thirds, ascending 
(Fig. 6i). On crossing the pubis a second 
time the roller is made to converge towards 

7 97 



THE ROLLER BANDAGE 

the former turn, so that when it reaches 
the crest of the iHum it will repeat it. Pro- 
ceed again to the thigh, and so continue until 

Fig. 6i. 




^ 



f 



/ 





Initial turns of the ascending spica of the groin. 



the bandage is exhausted. In securing the 

terminal end, thrust the pin in a sufficient 

depth to include any dressing which may have 

98 



BANDAGES OF THE LOWER EXTREMITY 

been applied, as the latter is very liable to 
becorae displaced (Fig. 62). 

Fig. 62. 





P 



Ascending spica of the groin. 



Uses. — To retain dressings to the groin, 
and to complete the application of splints to 
the thigh. 



L.ofC. 



99 



THE ROLLER BANDAGE 
DESCENDING SPICA. 

Fix the initial extremity at the uppermost 
portion of the thigh. Carry the roller across 

Fig. 63. 




Initial turns of the descending spica of the groin. 



the highest part of the abdomen which it is 
intended to cover, and proceed across the 
back to the groin In this bandage the upper 



BANDAGES OF THE LOWER EXTREMITY 

border of the roller forms the spica ; this turn, 
therefore, must cross the preceding one so 
that their upper borders coincide directly in 
front (Fig. 63). Encircle the thigh, overlap- 

FlG. 64. 




Descending spica of the groin completed. 



ping, descending, two-thirds. Pass the roller 
across the abdomen and make it converge 
towards the former turn, so that when the 



THE ROLLER BANDAGE 

opposite side is reached it will repeat it, when 
it at once beg-ins to divero-e towards the orroin. 
So continue until the roller runs out, when 
the terminal end is pinned deeply over the 
spica (Fig. 64). 

Uses. — The same as the preceding bandage. 
It is often not decided which of these to apply 
until after the first turn is made, when it may 
seem desirable to extend the turns above or 
below the starting-point. 



Double Spica Bandage of the Groin. 

lYz inches by 10 yards. 
ASCENDING SPICA. 

Fix the initial extremity upon the upper 
portion of the right thigh, or retain it with the 
thumb of the left hand until the first turn is 
made (the latter economizes the bandage). 
After encircling the thigh, carry the roller 
across the pubis to the left iliac crest and 
directly across the back to the corresponding 
point on the right side. Passing over the 



BANDAGES OF THE LOWER EXTREMITY 



pubis again, encircle the left thigh, and re- 
turn by the back to the starting-point in 
front of the right thigh (Fig. 65). Three 



F::-, 






Initial turns of the double ascending- spica of :he ^r 



spicas are begun in the first series of turns, 
and as each intersection of the lower border 
of the roller determines the location of these 
spicas, each must be made in its proper place 

103 



THE ROLLER BANDAGE 

respectively in the median line of the abdo- 
men and directly in front of each thigh. So 
continue overlapping two-thirds, ascending in 



Fig. 66. 




Double ascending spica of the groin. 

front and repeating behind, in the order right 

thigh, body, left thigh, body, right thigh, etc., 

until three or four complete turns have been 

made, when the terminal end may be pinned 

over a spica (Fig. 66), 

104 



BANDAGES OF THE LOWER EXTREMITY 

Uses. — To retain double hernia. To make 
pressure or apply dressings to both groins. 

DESCENDING SPICA. 

Fix the initial extremity on the uppermost 
portion of the right thigh, or retain it with the 

Fig. 67= 










1 

Initial turns of the double descending- spica of the groin. 

thumb of the left hand until the first turn is 
made. Having encircled the thigh, carry the 

105 



THE ROLLER BANDAGE 

roller across the highest part of the abdomen, 
which is to be covered, to the opposite side. 
Cross the back horizontally, and descend over 

Fig. 6S. 




Double descending spica of the groin. 

the abdomen to the left thigh, and encircle it. 
Convey the roller again across the back, de- 
scending on the right side to the starting- 
point over the right thigh (Fig. 67). Here, 

106 



BANDAGES OF THE LOWER EXTREMITY 

as in the preceding dressing, there are to be 
three spicas. The intersection of the upper 
border of the roller in the median line and in 
front of each thigh determines, therefore, the 
position of each spica. So proceed, over- 
lapping two-thirds, descending in the order 
just described for the ascending spica, until 
three or four complete turns have been made, 
when the terminal extremity may be pinned 
over either spica (Fig. 68). 

Uses. — The same as the preceding bandage. 
Whether to employ one or the other is often 
decided, as in the single spica, after the first 
turn is made. 



Figure-of-eight Bandage of the Knee. 

2^ inches by 2 yards. 

Fix the initial extremity by circular turns 

over the patella. On reaching the popliteal 

space the third time carry the roller upwards, 

so that a turn shall be made which overlaps 

the fixing turns two-thirds, ascending. On 

returning to the back of the joint carry the 

107 



THE ROLLER BANDAGE 

roller downwards, so that a turn shall be made 
which overlaps the fixing turns two-thirds, de- 
scendinor. Thus alternate above and below 
the joint with turns which continue to diverge 
from the patella, but overlap (approximately) 
at the popliteal space until three complete fig- 
ures-of-eight have been made, when the termi- 
nal extremity is pinned at any point (Fig. 69). 



Fig. 69. 




Figure-of-eight bandage of the knee. 




Wlien this bandage is used as a part of the 
spiral reversed of the lower extremity, a slight 
modification in the lay of the initial and ter- 
minal turns becomes necessary. 



108 



BANDAGES OF THE LOWER EXTREMITY 

Uses. — To retain splints and dressings to the 
knee-joint, and as a part of the spiral reversed 
bandage of the lower extremity. 



Spica Bandage of the Foot. 

T^yi. inches by 3 yards, for the foot alone. 

Fix the initial extremity at the ankle, and 
convey the roller abruptly across the dorsum 
of the foot to the base of the toes. Around 
the foot at this point make a circular turn, 
then a spiral, and proceed to the heel. The 
roller crosses the latter at a point which will 
brinor its lower border on a level with the sole 
of the foot. Thence return across the dor- 
sum and make the first spica. The lower 
border of the roller beine the euide for the 
proper location of the spica turns (as this is 
an ascending spica), it must intersect the 
lower border of the preceding turn in the 
median line of the foot and overlap three- 
quarters, ascending. Unlike all other spicas, 

this ascending overlap does not converge at 

109 



THE ROLLER BANDAGE 

any point, but continues a three-quarter over- 
lap throughout the entire course of each turn, 
behind the heel, as well as around the foot. 
Another foot turn being completed, the roller 
is carried to the heel. So foot, and heel turns 
alternate until the former is completely cov- 
ered, and the latter, except at its point (Fig. 



Fig. 70. 




Spica bandage of the foot- 



'^'■\ . V 



70). The terminal end may be pinned at any 
convenient point, or the bandage continued 
up the leg. 

Uses. — To retain dressings to any part of 
the foot. To make pressure or give support. 



BANDAGES OF THE LOWER EXTREMITY 

Also to commence the spiral reversed bandage 
of the lower extremity. 



Incomplete Bandage of the Foot. 

2^ inches by 2 yzwrds, for the foot alone. 

Fix the initial extremity at the ankle, and 
carry the roller across the dorsum of the foot, 

Ftg. 71. 



"IP"^^^ 






Initial turns of the incomplete bandage of the foot. 

as in the preceding dressing. Make one cir- 
cular, one spiral, and one spiral reversed turn 



THE ROLLER BANDAGE 

around the foot, overlapping two-thirds, as- 
cending (Fig. 71), and proceed across the in- 
step to the ankle. Here make a circular, and 
again crossing the instep, make another foot 
turn. The ankle and foot each receive an- 
other turn, overlapping the preceding one 

Fig. 72. 




The incomplete bandage of the toot. 

two-thirds, when the terminal end is either 
pinned at the ankle or the roller continued up 
the leg (Fig. 72). The heel is not covered. 

Uses. — To retain dressings, and to com- 
mence the spiral reversed bandage of the 
lower extremity. 



BANDAGES OF THE LOWER EXTREMITY 
Complete Bandage of the Foot. 

2j^ inches by 3 yards, for the foot alone. 

Fix the initial extremity at the ankle, carry 
the roller across the foot, make a circular turn, 



Fig. 73 




Showing: the heel turn in the complete b?.ndage of the foot, 

a spiral, and a spiral reversed, all as in the 

dressing just described. Starting, after these 

turns have been made, at the instep, carry the 

roller across the point of the heel and back 

again to the instep (Fig. j^). From there 
8 113 



THE ROLLER BANDAGE 

pass to the sole of the foot, and around the 
side of the heel under the malleolus (the 
outer, if the right foot, the inner, if the left), 
to the tendo Achillis (Fig. 74), and to the 
instep. Again to the sole of the foot, beneath 



Fig. 74. - 




Showing- the inner malleolar turn in the complete bandage of the foot. 

the other malleolus to the tendo Achillis, and 
back to the instep (Fig. 75). The terminal 
extremity is either pinned here, or the roller 
carried up the leg. The turns under each 
malleolus must also be pinned. This band- 
age covers the heel. 

114 



BANDAGES OF THE LOWER EXTREMITY 

Uses. — To retain dressings, and make uni- 
form pressure upon the ankle-joint. Also to 



Fig. 75. 



.t^ 





Showing- the outer malleolar turn in the complete bandage of the foot. 

commence the spiral reversed bandage of the 
lower extremity. 



115 



THE ROLLER BANDAGE 

Spiral Reversed Bandage of the Lower 
Extremity. 

2j^ inches by 7 yau:ds to the knee, 14 yards to the groin. 

Fix the initial extremity, and cover the foot 
by either of the three methods above de- 
scribed. After the foot has been covered, 
proceed with spiral turns, overlapping two- 
thirds up the leg, until its increasing diameter 
necessitates reverses. After which spiral 
turns, or if the calf be very much swollen or 
a bulky dressing has been applied to it, de- 
scending spiral reverses, continue until the 
knee is reached. The terminal end is here 
pinned. If the roller is to be carried up to 
the groin, figure-of-eight turns will be made to 
cover the knee (see page io8), and spirals and 
spiral reverses, as indicated by the contour of 
the limb, will complete the dressing (Fig. 

76). 

Uses. — To retain dressings, splints, exten- 
sion apparatus to the part, and to give sup- 
port for various conditions. 

116 



BANDAGES OF THE LOWER EXTREMITY 



Fig. 76. 



^R?' 




..^ 



Spiral reversed bandage of the lower extremity. 



117 



T-Banda£[es, Slings, Binders, and Knots. 



T-BANDAGES, slings, binders, and knots, while 
not always made of the roller bandage, may 



Fig. 77. 




Single T-bandage. 



properly be described, because the latter may 
be used for the purposes of them all and 



118 



T-BANDAGES 

because a description of them in this connection 
will probably best demonstrate the principles 
of their mode of construction, their form, and 
their uses. 

T-Bandages. 

A T-bandage consists of two rollers, the 
one a single, the other a double roller sewn 

Fig. 78. 




Double T-bandage. 

together at a right angle. It may be made of 
any material, though usually of gauze or mus- 
lin, and the two rollers composing it may be 

of equal width, as shown in Fig. ']^, or they 

119 



THE ROLLER BANDAGE 



Fig. 79o 




T-bandage of the chest. 



1 20 



T-BANDAGES 

may vary to any extent in all their dimensions. 
The double T- bandage, seldom used, is shown 
in Fig. 78, which, like Fig. ']^, represents a 
bandage made of gauze. 

The T-Bandagc of the Chest. — The T-band- 
age of the chest consists of a double roller, fifty 
inches long by ten inches wide, to the middle 
of which is sewn at a right angle a single 
roller thirty inches long and four inches wide. 
The broad portion is applied to the chest, and 
being drawn to the state of tension desired, is 
retained in position by safety-pins neatly in- 
serted at regular intervals. The narrow strip 
is then carried over the shoulder and fastened 
in front to keep the chest bandage in place. 
(Fig. 79.) The double T-bandage of the 
chest having two tails, one is carried over 
each shoulder. 

The T-Bandage of the Pubis. — The T-bandage 
of the pubis consists of a strip of muslin 
eighteen inches long and six inches wide, to 
which is sewn a double-headed roller thirty 
inches long and three inches wide. The 



THE ROLLER BANDAGE 



Fig. 8o= 




T-bandage of the pubis. 



122 



T-BANDAGES 

broad portion is applied to the pubis and 
beneath the perineum, while the narrow band- 
age is carried around the lower abdomen and 
attached to the extremity of the broad band- 
age over the sacrum. (Fig. 80.) It may, at 
times, be convenient to split the posterior 
portion of the broad bandage into two tails 
three inches wide in order to attach them at 
the loin on either side to the long tails. 

The T-Bandagc of the Ear. — The T-bandage 
of the ear consists of a double-headed roller 
two yards long and one inch wide, to the 
middle of which is sewn a single roller one 
yard long and one inch wide. The double- 
headed roller is applied to the vault of the 
cranium, while the single roller, retaining any 
dressing applied to the ear, is carried verti- 
cally around the face. 

T-bandages are used to retain light dress- 
ings to the part. 

Other T-bandages may take the place of 

certain slings presently to be described, but 

the latter will generally be found more useful. 

123 



THE ROLLER BANDAGE 

Slings. 

The sling most commonly used is that to 
support the upper extremity. A two-and- 

FiG. 8i, 




Roller bandage sling of the forearm. 

a-half-inch roller carried around the neck 

and wrist is given a hitch just above the 

latter, as shown in Fig. 8i. The ends are 

124 



SLINGS 



then drawn upon sufficiently to get the re- 
quired elevation of the forearm, when they 
are made into a knot which includes in it the 



Fig. 82. 




liaiidkerchief sling of the forearm. 



free portion of the roller. This sling is use- 
ful after minor injuries of the fingers and 

hand and to keep up slight restraint of the 

125 



THE ROLLER BANDAGE 

arm after splints or dressings for various fract- 
ures and dislocations have been discarded, but 
it is not appropriate for the support of heavy 



Fig. S3. 




Four-tailed sling. 

splints or dressings, as the weight of the latter 

concentrates the pressure too much at the 

wrist. For these, a handkerchief sling made 

of a piece of muslin one yard square, folded 

126 



SLINGS 

diagonally and applied as shown in Fig. 82, 
gives much better support by distributing the 
pressure throughout the whole forearm. 

Four-Tailed Sling. — This can be quickly made 
by folding a strip one yard long of a two-and- 



FlG. 84. 





Four-tailed sling of the eye. 

a-half-inch roller and scoring it with scissors, 
as shown in Fig. 83. The scored portion is 
then torn out, leaving four tails attached to the 
sling. 

127 



THE ROLLER BANDAGE 

Four-Tailed Sling of the Eye. — Applying the 
sling to a dressing of the eye, the upper tails 
are carried around the head above the ears 
and tied at the back, while the lower tails are 
carried below the ears and tied also at the 
back of the head, as shown in Fig. 84. 

Fig. 85„ 



A 




r 



\ 



Four-tailed sling of both eyes. 



Four-Tailed Sling of Both Eyes. — For this 
dressing the scoring of the roller is done at a 
point in the fold which will make a sling as long 



128 



SLINGS 

again as that required for one eye. The sling 
is applied to both eyes, the upper tails being car- 
ried above the ears and the lower tails beneath 
the ears and all tied at the back of the head. 

(Fig- 85-) 

^ ^ ^ ^ Fig. S6. 




Four-tailed sling of the ear. 

Four-Tailed Sling of the Ear, prepared as the 

sling for one eye, retains a dressing upon the 

ear. The upper tails are carried around the 

head and crossing one another on the opposite 
9 129 



THE ROLLER BANDAGE 

side are brought back around the neck and 
made into a knot, while the two lower tails 
are carried abruptly down to the neck and 
tied to the former, as shown in Fig. 86. 

Four-Tailed Sling of the Chin. — This is pre- 
pared by scoring the folded roller to make 



Fig. 87- 




Four-tailed sling ol* ihe chin. 

the tails, and, at the same time, snipping the 
corner of the fold out with the scissors, in 
order to leave a hole in the centre of the 
sling. Placing the sling upon the chin, the 

130 



BINDERS 



upper tails are carried along the jaw on 
either side and tied at the back of the neck, 
while the lower tails ascending the sides of 
the face are first tied at the vertex, and, after 
continuing as one from the knot, are fastened 
at any convenient point to the other tails, as 
shown in Fio-. 87. This is a useful dressincr 
to Hmit the movements of the inferior max- 
illary after dislocation and to retain dressings. 



Binders. 

Instead of a single bit of broad muslin, 
pinned or otherwise fastened to give sup- 
port or retain dressings to a part, strips of 
roller may be sewn together at their edges, 
leavinof their ends free and thus formino- a 
many-tailed sling. The binder or sling thus 
made is seldom used except for the abdomen, 
though it may be adapted for other purposes. 
The binder used after all abdominal opera- 
tions is usually made of canton flannel each 
strip being one yard-and-a-half long and 
four inches wide. Six of these, spread out 

131 



THE ROLLER BANDAGE 

smoothly upon a table so that they shall over- 
lap one another one-half of their width, are 
sewn together at their middle third by a cat- 
stitch, as shown in Fig. 88. 

Their free ends are rolled upon strips of 
cardboard into a compact form which can 

Fig. 88. 




ny-tailed binder. 



easily be slipped under the patient. The re- 
production represents the tails on the right 
partially rolled upon the strip of cardboard. 
The binder is applied by inserting one roll 
beneath the back as the patient lies in bed 
and unrolling the tails on either side. The 

uppermost pair of tails is carried across the 

132 



BINDERS 



Fig. 89. 




^■. 



Method of applying the binder. 







^33 



THE ROLLER BANDAGE 

lower portion of the chest in opposite direc- 
tions and held in place by the hands of an 
assistant while the next two lower tails are 
being similarly applied. (Fig. 89.) So each 
pair of tails in turn is adjusted until the low- 
est one is finished, when it is fastened with a 
safety-pin. At times it may be necessary to 
pin each tail if very firm support is required. 



Knots. 

Various knots, usually made in the form 

Fig. 90c 




Double half-hitch of roller bandage. 

of a double half-hitch, are occasionally used for 
the purposes of temporary traction or exten- 

134 



KNOTS 

sion. Thev mav be made of a bit of roller 
bandage (Fig. 90), of a handkerchief, or of a 
sheet (Fig. 91). When it is desired to use 

Fig. 91. 




Double half-hitch of a sheet. 

forcible traction in efforts at reduction of dis- 
locations of the hip-joint or of old dislocations 
of the shoulder-joint, one sheet is thus knotted 
at the ankle or wrist, while another passed 

135 



THE ROLLER BANDAGE 

over one shoulder and under the other arm 
of the operator is tied through a loop made 
of the tails of the first sheet. A slight modi- 
fication of such a hitch is a convenient form 

Fig. 92= 




Ankle hitch for temporary extension. 



of making moderate extension on the foot, 
but the pressure is too much concentrated 
behind the ankle and at the instep to allow of 
much weight. This knot is shown in Fig. 92. 



136 



Plaster-of-Paris Bandages. 



These are best prepared in the following 
manner : Cut crinoline with scissors into 
strips seven yards long and two-and-a-half 

Fig. 93. 




Method of making plaster bandages. 

inches wide, and roll them loosely by hand, 
wath the key, or with the machine (see 
page 13). Unrolling the initial extremity of 
a bandage to the extent of one yard, spread 



THE ROLLER BANDAGE 

upon it with a spatula a layer of dry plaster- 
of-Paris about one-sixteenth of an inch thick, 
as shown in Fig. 93. This portion of the 
bandage is firmly rolled so that it will retain 
as much of the plaster as possible between 
its layers. Another similar length is then 
spread and rolled, and thus the process is 
continued with the whole bandage. A rubber 
band is applied to retain it, it is wrapped in 
wax paper to exclude moisture, and is then 
ready for use. 

Method of Applying the Plaster-of-Paris Band- 
age. — The bandage is immersed, standing on 
end, in cold water. When it ceases to yield 
bubbles of air, it is carefully removed from 
the water and pressed firmly in the hand to 
make it as dry as possible. It is then ready 
to be applied. 

Mode of Application of Plaster-of-Paris Band- 
ages. — Though applied for other purposes, the 
plaster-of-Paris bandage has these three uses 
to which it is most commonly put : as a fixed 
dressing after fracture of the leg ; as a dressing 

138 



FIXED DRESSINGS 

to immobilize the thigh, the hip-joint, and 
the pelvis after fracture, or in the treatment 
of coxalgia ; and in the form of a jacket 
applied to the trunk in the treatment of 
diseases of the spine. 

Application of Fixed Dressings to the Leg. — 
The limb should be perfectly under control 
while the plaster-of-Paris is being applied. 
Three trained assistants are required, one to 
support the thigh, another to support the leg 
and foot, and the third to assist the surgeon 
with the plaster bandages and the manipu- 
lation of the plaster-of-Paris. If so much 
help is not at command, some device which 
will support the limb in proper position may 
be used: Two uprights (clothes-props), at- 
tached vertically to the head and foot of the 
bed, are joined by a third horizontal bar rest- 
ing upon them and held in place by cord or 
wire nails. The patient lies in bed in such a 
position that the fractured leg is directly be- 
neath the horizontal bar. The fractured leg 
is then placed upon two pillows, which will 

139 



THE ROLLER BANDAGE 

elevate it about five inches 6*0111 the bed, 
producing thereby slight flexion of the knee- 
joint. Rubber adhesive suspension straps 
are then applied to the middle of the thigh 
and the foot. These are turned upon them- 
selves so that they shall form a loop above 
through which a cord can be passed, which, 
having been drawn taut, is made fast to the 
horizontal bar. On removing the pillows, the 
limb may be found sufficiently supported. If 
a third point of support is needed, it should 
be in the form of a prop from beneath the 
limb to the bed. For this purpose a slender 
stick, like a lead-pencil, cut to the proper 
length and padded with a little knob of 
muslin, is placed at the desired point, there 
to remain until the application of the plaster- 
of-Paris bandage is completed. By a little 
experimental slackening and tightening of the 
suspension cords, the limb will finally be sus- 
pended in a very correct position without any 
manual aid. This method of preparing the 

leg for the application of a fixed dressing is 

140 



FIXED DRESSINGS 




Method of suspending a fractured leg for the application of a fixed dressing. 



141 



THE ROLLER BANDAGE 

shown in Fig. 94. Gentle pressure with the 
finger or between the fingers and thumb at 
some point where slight deformity persists 
may, at times, be necessary to perfect the 
modelling process. Having applied a flannel 
bandage from the foot to just below the knee 
or just above the knee according to the point 
to which it is intended that the dressing shall 
reach, the plaster bandages, starting from the 
toes, are used as an ordinary roller, except 
that they seldom need reversing. 

Having applied from three to six bandages, 
according to the degree of firmness required, 
free plaster, mixed with water to the consist- 
ence of thick cream, is smoothly spread over 
the dressing with the hands, thickly enough 
to completely hide the turns of the bandage. 
When this layer has begun to set, a very 
bright, shining surface may be given to it by 
rubbing with a pad of cotton saturated with 
alcohol. 

In the use of plaster-of-Paris, the proper 

care of the hands should not be overlooked. 

142 



FIXED DRESSINGS 

A little vaseline applied in and around the nails 
facilitates the removal of the plaster from the 
finger-tips, while the unpleasant harshness of 
the skin, which the plaster causes, is best re- 
moved by granulated sugar. The latter is 
used by simply dissolving it upon the fingers 
with plain water. 

A window or trap-door in a plaster of-Paris 
dressing, in order to give access to a wound, 
especially one of compound fracture, may be 
conveniently made in the following manner : 
A half-inch band of lead tape of a length 
equal to the circumference required for the 
window is formed into a loop or ring by 
closing the ends together with a bit of rubber 
adhesive plaster. This is applied to the limb, 
and, modelled into an ellipse, circle, or square, 
is held in position by the initial flannel band- 
age, which also retains the wound-dressing. 
After the plaster-of-Paris has set, the outline 
of the lead wall, being distinctly apparent, is 
cut down upon with a penknife, except at one 
point which is to act as a hinge, and the lead 

143 



THE ROLLER BANDAGE 

band removed, as shown in Fig. 95. Beneath 
the everted flange-Hke edge of the window 
absorbent cotton should be inserted in order 
to prevent the leakage of blood or pus be- 
tween the fixed dressing and the skin. The 
trap thus formed is afterwards kept in place 

Fig. 95. 




Showing trap-door, also vertebrated chain employed to facilitate the removal of 
the fixed dressing. 

by a bandage. Should the window exceed in 

width one third the circumference of the limb, 

the dressing may be reinforced by strips of 

tin laid at the back during the application of 

the plaster bandages. In this way extensive 

144 



FIXED DRESSINGS 

compound fractures of the leg may often be 
appropriately managed. 

Plastcr-of-Paris Dressings of the Hip. — The 

pelvis may be elevated from the bed and so 
held by the hands of an assistant, or, if the 
patient is an adult, this posture may be con- 

Fig. 96. 





Pelvic rest used for the application of a fixed dressing to the hip. 

veniently maintained by the use of the metallic 
rest, as shown in Fig. 96. A flannel roller in 
the form of a spica of the groin extended well 
around the hip and including the buttock is 
first applied in order to protect the skin from 
contact with the plaster. The plaster band- 
ages to the number of from three to six, accord- 
10 145 



THE ROLLER BANDAGE 

ing to the size of the pelvis and the require- 
ments of firm fixation, are applied somewhat 
in the form of a spica, so modified, however, 
that the upper third of the thigh and buttock, 
hip and pelvis will all be covered. Between 
layers of these bandages longitudinal strips of 
tin or sheet-iron, half an inch wide, may be 
inserted to give additional strength. In the 
same way, any metal splint employed should 
be inserted between the strips of bandage. 

Plastcr-of-Paris Jacket. — The patient, wearing 
a closely-fitting undershirt, is placed in a posi- 
tion tending more or less to correct the de- 
formity of the spine ; if by suspension, as 
shown in Fig. 97, the hips must be steadied 
by an assistant during the application of the 
plaster bandages, which are begun immedi- 
ately upon the undershirt and are carried 
from a point just below the crests of the ilia 
to the level of the axillae. From three to six 
rollers are usually required to give sufficient 
firmness, when the whole is covered with a 

smooth-spread layer of plaster-cream. 

146 



PLASTER-OF-PARIS JACKET 



Fig. 97, 




Suspension apparatus for the application of a plaster-of- Paris jacket. 



147 



THE ROLLER BANDAGE 

The dressing is applied in a similar manner 
if some other posture than that of suspension 
is used. Fig. 98 represents the method of 
retaining the spine in a more or less corrected 
position by the use of a hammock. Such an 

Fig. 980 




Hammock for the application of a plaster-of-Paris bandage. 

apparatus may be made as an ordinary ham- 
mock with a strip of muslin two yards long 
and a yard wide, at the ends of which are sewn 

broad hems. Into these hems at either end is 

148 



THE REMOVAL OF FIXED DRESSINGS 

inserted a broomstick, or the hammock may 
be stretched from the head to the foot of the 
bedstead. The patient Hes in the position 
which best corrects the deformity, and the 
hammock is made to sag to a degree which is 
found by experiment to give the best result. 
Two holes are cut in it, through which the 
patient's legs are thrust, and the bandages 
are then applied. They include in their turns 
the hammock as well as the undershirt ; the 
former after the plaster has set being cut off 
with scissors at the upper and lower edges of 
the dressing. 

The Removal of Fixed Dressings. — The pre- 
liminary steps to facilitate the ready removal 
of fixed dressings are often taken when the 
dressing is being applied. A strip of lead 
tape placed upon the limb, the length the 
dressing is planned to be, next to the skin, 
protects the latter from the point of a pen- 
knife which may be used to make a long sec- 
tion in the dressing immediately after the 
plaster has set. The lead tape is then with- 

149 



THE ROLLER BANDAGE 

drawn. Some device, however, which leaves 
in the dressing a hollow longitudinal ridge best 
prepares it for easy removal. A convenient 
device for this purpose consists of a T-shaped 
rubber strip provided at one end with a knob. 
Fig. 99, and so formed that when it is placed 

Fig. 99. 





T-shaped rubber strip. 



Upon a part prior to the application of a fixed 
dressing, it will, on withdrawal, as soon as the 
dressing has set, leave behind it in the latter a 
hollow longitudinal ridge. This may be readily 
divided by a knife or plaster shears at any time 
it is desired to remove the dressing, and, a 

150 



THE REMOVAL OF FIXED DRESSINGS 

clean, straight cut being thus made, the splint 
will be in a suitable condition to reapply if 
necessary. As applied to the part, the strip 
presents on cross-section the form of an in- 
verted T ; and although it increases the circum- 
ference of the limb a fraction of an inch, it does 
not affect the proper tension of the dressing. 
When a hinge in the dressing is required, two 
strips are applied, the ridge formed by the 
one in front being cut, while that behind 
makes the joint. If the strip has to travel 
over a very sharp curve, it should be wrapped 
in wax-paper in order to lessen friction on 
withdrawal. The strip is placed upon the 
limb after the initial flannel bandage has been 
applied, and is held in position until the turns 
of the plaster bandage themselves retain it. 
After the dressing has set, traction upon the 
strip easily withdraws it, because its thickness 
is diminished by stretching. If this apparatus 
is not at hand, a piece of rope covered with 
wax-paper may be improvised for the purpose. 
Whether such a hollow ridge has been made 
151 



THE ROLLER BANDAGE 

in the dressing or not, either of the following 
instruments may be used to cut through it. 

Reed's cutter is perhaps the most generally- 
useful device for cutting plaster dressings. 
It is shown in Fig. lOO. With it a clean cut 
is easily and rapidly made by the upper blade, 
which has a rotary movement, and is pre- 

FlG. lOO. 




Reed's cutter. 

vented from slipping by the serrations on its 
anterior edore. 

Van Brun's cutter (Fig. loi) is a powerful in- 
strument, but the leverage it exerts is liable 
to be too great for the strength of the lower 
blade. Short cuts at a time must therefore be 

made with it. 

152 



THE REMOVAL OF FIXED DRESSINGS 



Fig. ioi. 



Fig. 1 02. 



Van Brun's cutter. 



Plaster shears. 



IS3 



THE ROLLER BANDAGE 

The shears shown in Fig. 102 will cut 
through a thin dressing, but are not adapted 
either by their power or their mode of action 
for section of heavy dressings. 

Darrach's cutter, shown in Fig. 103, is an 

Fig. 103. 




Darrach's cutter. 



ingenious device which operates by the action 
of a rachet upon the cutter. 

Pearson's circular saw is shown in Fig. 104. 
It, at times, works admirably, and slightly 

154 



THE REMOVAL OF FIXED DRESSINGS 

modified, so that its handle would draw in 
line with the saw instead of to one side of 

Fig. 104 




Pearson's circular saw. 



it, it micrht be made a most useful instru- 



ment. 



FiG= 105. 




Saw. 



With the saw shown in Fig. 105 any plaster 
dressing may be removed, but its work is slow 

155 



THE ROLLER BANDAGE. 

and laborious. It is, however, useful at times 
in conjunction with one of the various cutters. 
A heavy pruning-knife with the concavity 
on the edge is also useful ; and if it is made 
to cut from within outwards, may be manipu- 
lated without risk of wounding the skin. 



156 



Index. 



Page 

Anterior figure-of-eight bandage of the chest 88 

Appliances for the removal of fixed dressings 149 

/application of fixed dressings 139 

of the roller bandage 20 

Ascending spica bandage of the groin 97 

of the shoulder 69 

of the thumb 81 

Bandages, anterior figure-of-eight, of the chest 88 

ascending spica, of the groin 97 

of the shoulder 69 

of the thumb 81 

Barton's 31 

circular 26 

complete of the foot 113 

crossed of the j aw 38 

demi-gauntlet 85 

Desault's 51 

double-headed recurrent, of the scalp 42 

figure-of-eight 28 

of the chest 88 

of the elbow 79 

of the eye 44 

of the knee 107 

of the neck and axilla 67 

gauntlet 83 

Gibson's 34 

Hunter's V 46 

incomplete of the foot iii 

knotted 49 

157 



INDEX 

Page 

Bandages, oblique 27 

occipito-facial 36 

of the head 29 

of the lower extremity 97 

plaster-of-Paris 137 

posterior figure-of-eight of the chest 90 

recurrent 21 

of the scalp 40 

special 26 

spica 27 

of the breast 91 

of the foot 109 

of the groin 97 

of the lower extremities 97 

of the shoulder 69 

^ of the thumb 81 

spiral 26 

of the chest 87 

reversed 28 

of the lower extremity 116 

of the upper extremity 74 

T- 119 

Velpeau's 63 

White's head and neck 48 

Barton's bandage 31 

Binders 131 

Circular bandage 26 

Complete bandage of the foot 113 

Darrach's plaster-cutter 155 

Demi-gauntlet bandage of the hand 85 

Desault's dressing 51 

modification of, by author 61 

Descending spica bandage of the groin 100 

of the shoulder 72 

of the thumb S2 

Double figure-of-eight bandage of the eye 45 

158 



INDEX 

Page 

Double-headed recurrent bandage of the scalp. 41 

Double roller bandage 19 

spica bandage of the breast 94 

of the groin 102 

Elbow, figure-of-eight bandage of the 79 

Figure-of-eight bandage 28 

of the chest 88 

of the elbow 79 

of the eye 44 

of the knee 107 

of the neck and axilla 67 

Fix, to 20 

Fixed dressings, application of, to the leg 139 

removal of 149 

Foot, complete bandage of the 113 

incomplete bandage of the . 11 1 

spica bandage of the 109 

Gauntlet bandage of the hand 83 

Gibson's bandage 34 

Groin, double ascending spica bandage of the 102 

descending spica bandage of the 105 

single ascending spica bandage of the 97 

descending spica bandage of the 100 

Hammock for the application of plaster-of-Paris jacket. . 148 

Hand, demi-gauntlet bandage of the 85 

gauntlet bandage of the 83 

rolling bandages by 10 

Head, bandages of the 29 

Hunter's V bandage 46 

Incomplete bandaging, dangers of 16 

bandage of the foot 1 1 1 

Key for rolling bandages 11 

Knee, figure-of-eight bandage of the 107 

Knots 134 

Knotted bandage of the head 49 

Lower extremity, bandages of the 97 

159 



INDEX 

Page 

Machine, bandage 13 

Oblique bandage 2'j 

Occipito-f acial bandage 36 

Overlap, to 21 

Parts of the roller bandage 19 

Pearson's plaster-saw 155 

Plaster-cutters and shears.. 152 

Plaster-of-Paris bandages 137 

application of 138 

method of making a window in 143 

removal of 149 

j acket 146 

hammock for application of 148 

Posterior figure-of-eight bandage of the chest 90 

Recur, to 21 

Recurrent bandage 21 

Recurrent bandage of the scalp 40 

Reed's plaster-cutter 152 

Remiove, to, a roller bandage 26 

Repeat, to 20 

Reverse, descending to 24 

Reverse, to 22 

Roller bandage 9 

definition of 9 

materials for 9 

method of application of 15, 20 

method of rolling 10 

parts of 19 

uses of 14 

Scalp, recurrent bandage of the 40 

Secure, to 25 

Single roller bandage 19 

spica of the breast 91 

of the groin , . 97 

Size of bandages 13 

Slings 124 

160 



INDEX 

Pace 

Slings, four-tailed 127 

four-tailed of the chin 130 

four-tailed of the ear 129 

four-tailed of the eye 128 

Special bandages . 26 

Spica bandage 2y 

of the breast 91 

of the foot 109 

of the groin, double ascending 102 

descending 105 

single ascending 97 

descending 100 

of the shoulder, ascending 69 

descending y2 

of the thumb, ascending 81 

descending 82 

Spiral bandage 26 

of the chest 87 

reversed 28 

of the lower extremity 116 

of the upper extremity 74 

T-bandages 119 

of the chest 121 

of the ear 123 

of the pubis 121 

Tension of the roller bandage 14 

influenced by the application of splints 16 

by a change in the position of the part 18 

by habit 18 

by incomplete bandaging 16 

by the character of the dressing beneath 16 

by the circumference of the part bandaged 15 

by the flexion and extension of the joints 17 

by the number of turns 17 

by the shrinkage of the muslin. 17 

by the situation 18 

II 161 



INDEX 

Page 
Tension influenced by the texture and condition of the 

tissues i8 

Trunk, bandages of 87 

Upper extremity, bandages of the 51 

Uses of the roller bandage 14 

Van Brun's plaster-cutter 152 

Varieties of roller bandages 19 

Velpeau's bandage 6s 

White's head and neck bandage 48 



THE END 



162 



J UN 9- 1902 



1 COPY Ot,l, TO CAT. DIV, 



..!02 



